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Home My WebLink About2962 PEMBA DR - Building Permits°�' "�Fso ot � • > _ t J � �ro� � (714)754-5273 • Fax(714)754-4856 CITY OF COSTA MESA BI/ILDING DIYISION � DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT Job Address: 2962 PEMBA DR Suite No Vicinity: AT REAR OF PROPERTY Parcel Nunmber: 13926231 Applicant: KENNEDY, PATRICK Address: 257 SANTA ISABEL CA COSTA MESA Owner: SCHUREMAN, ROBERT A TR Address 2962 PEMBA DR COSTA MESA, CA Phone: (714) 646-7686 Zip: 92626 Phone: Zip: 92626 Contractor: KENNEDYS CONSTRUCTION Address: 257 SANTA ISABEL CA Phone: (714) 646-7686 COSTA MESA Zip: 92626 License: 324307 ArchlEng: Address: Phone: Zip: License: NUMBER P99-00610 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 10/26/1999 Issued: 10/26/1999 SCOPE OF PERMIT PLUMBING PERMIT FOR ADDITION & REMODEL OF EXISTING SINGLE FAMILY RESIDENCE. INSTALL 7-PRIVATE SEWER LINE, 1-SHOWER, 1-WASH BASIN SET, 1-WATER CLOSET 8 1-WATER HEATER. REF: B99-01351 ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $o.00 50.00 50.00 $0.00 50.00 50.00 50.00 50.00 so.00 50.00 50.00 $0.00 30.00 50.00 £0.00 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank 50.00 SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Pnvate Line $24.65 Shower $g.80 Sink, bar $0.00 Sink, commercial $0.00 Sink, floor $0.00' Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trep Primer Urinal Vacuum Brkr Bkflow(7-4) Vacuum Brkr 8kflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater I vent Water Piping Qnst or Rep.) Water Re-pipe . Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $9.80 50.00 59.80 512.30 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 TOTALCALCULATEDFEES: $89.85 QTY 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a panod of 180 days. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicabla codes, and all required Inspectiona and (inal approvel must be obtained. Feilure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 WORKERS'COMPENSAnON DECLARAYION: I hereby ettirm under penalry oi perjury one oi the following declaretions: ❑ I heve and will maintain a certificate o� ��sent to self-Insure for workers' compensation, as provitletl tor by section 3700 of [he Lebor Cotle, for the paAormance of the wark tor which lhis permit is issuetl. ❑ I have antl will maintain workers' compenution insurance, as required by section 3700 of Ihe Lebor Code, for the pedortnance of Ihe work for which ihis pertnit is issued. My workars'spr�ery�tion Incuranca Parrier and policy number are: Carnar: (This se ❑ 1 certify Ihat in the peAor th ork fo compensation laws ot C d' end ea t d I comply with these pra ' n Applicant Signature: WARNING: FAILURE TO SECURE WORKERS P SATION ( THOUSMlD DOLLARE (5100.000�. IN ADDfTIIXJ TO TME COST OF LICENSED CONTRACTOiiS DECLARATION: I hereby aMirm iha! I am licensetl tler ro i' force and effect. Lic. # COnh9clor'S Signaiu — Polity Number: ar Iess.J s permit Is Issued, I shall not employ any person in any manner so es to becoma subject to the workers' become subfect to the workere' compensation provisions of Section 3700 of the Lebor Code, I shall forthwith _ Date: �/� �� SHALL SUBIECT qN EMPLOYER TO CRIMINAL PENALTIES AIJD GVIL FI S UP TO ONE HUNORED i PROVIDED f-0R IN SECTION 3lW OF THE LABOR CODE, INTEREST, AND AiTORNEYS FEES. 9(commencing with Sec�ion 7000) oi Division 3 of the E qass a Date: Professions Cotle, and my license is in full CONSTRUCTIOWLENDING AGENCY: � " ❑ I hereby attirm ihat ihare is a construction lending egency for ihe peAortnanca of the work Por which this permit is issuea. (Sec. 3097, Civil Code). Lentler's Neme: Signature: _ OWNER-BUILDER DECLARATIONS: Lentlafs Address: Date: I hereby eHirm that untler penalry of perjury ihat I am EXEMP7 FROM THE CON7RACTORS LICENSE LAW for ihe following reason (Sac. 7031.5, Business and Professions Code: Any ciry or counry which requires a pe�mit to wnstruct, alter, improve, aemolish, or repair any strucWre, pnor to its issuance, also requires the applicant for such permil to file a signed statement Ihet he or sha is IlGensed pursuant to the provisions oi ihe Coniraciors license Lew (Chapter 9(commencing with Section 7000) of Dlvision 3 of Ihe Business antl Professions Code) or thal he or she is exempt therelrom and the basis tor Ihe elleged ezemption. Any violation of Section 7031.5 by eny applicent tor a permit sub�acts the applicant to a civil penalry of not more ihan five hundred dollars ($500).): ❑ I. as owner of Ihe property, or my employees with wages es their sole compensation, WILL DO THE WORK, and the structure Is not intendetl or oHered lor sale (Sec. 7044, Business antl Protessions Code: The Contractors License Ww tloes not apply to an owner ot properry who builtls or impmves ihereon, and who tloes such work himself or herself or ihrough his or her own employees, providetl �hat such improvements are not intentletl or oftared for sale. If, hawever, iha builtling or improvement is soltl within one year of completion, ihe owner-builder will heve the burtlen oi proving Ihat he or she tlid not builtl or improve for purpose of saleJ. ❑ I, as owner of the property. am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to consiruct the prolect (Sec. 7044, Business antl Professians Coda: The contractore License Law does not apply to en owner of proDerry who builtls or impmves thereon, and who conirects for such project with a comrector(s) license pursuant to the Contractors License Laws.). ❑ I am ezempt under sec. Business and Professions Code for this reason: � SigneWre: Date: Owner ID venfietl by dnvefs liCenSe. ❑ Ves ❑ No Dnvers License N0. Expire5: Venfication of Ownership by (type of tlaument, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certiy that no ezcavation tive (5) or more feet in tlepth into which a person is requiretl to descenQ will be made in connection with work authonzed by ihis permit, antl ihat no building siructure, scaMolding, talsework, or tlemolition or dismanNing thereol, will be more t�an thirty-six (36) fee� high. (Chap. 32, Grp 2, Atl 2, Sec. 3a1, Ttle B, Calitornia Atlministretive Code). ❑ A5 owner-builder, 1 will not employ any0ne to tlo work which would require a pertnit from t�e Division of Intlustnal Safety, es notetl above, unless such person has a permit to da such work from Ihe tlivision. SignaNre: Oate: Division of Intlustrial Safery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIZA710N OF EMRV: I cetlify under penelty ot perjury that I have read this application and slate �hat Ihe information givan is correct. I agrea to comply wit at lews ciry ordinances raleting to building cons�mction, end au�horize representatives of the City of Costa Mesa to enter upon the above-descnbetl property f msp tiq� pu �.J.�gyee not to occupy or ellow occupancy of any builtling authorizetl by Nis permit untll flnal inspadion. [dI7�.'I�CFi9��L[9:�171� 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fira Place 203 Final Sign 204 Final Demolition 246G46 P� INililpl5 CODE♦ INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Finel Elec�rical 212 Final Fire Prevention 220 Final Planning Approval 222 Flnal Site 250 FinalBuiltling�Occupancy pRTE IMRIRLS � oz� G�L�i (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA B!/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT .lobAddress: 2962 PEMBA DR Suite: Vicinity: GARAGE/BEDROOM Parcel Number: 13926231 npp�icant: PATRICK KENNEDY Address: Owner: SCHUREMAN, ROBERT A TR Address 2962 PEMBA DR Zoning: Rl R1 Phone: (949)646-7686 Zip: Phone: COSTA MESA, CA Zip: 92626 Contractor: KENNEDYS CONSTRUCTION Address: 257 SANTA ISABEL M NUMBER., 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 8/24/1999 Issued: 10/26I7999 ISSUED BY: � Phone: 646-7686 COSTA MESA,CA _ Zip: 92626 License: 324307. : � Arch : APEC Eng: Address: 732 N DIAMOND BAR BLVD. #228 Address: Phone: (909)612-0114 Phone: DIAMOND BAR, CA Zip: 91765 License: License: SCOPE OF PERMIT CONVERT EXISTING 438 SF GARAGE TO BEDROOM & ADD NEW 420 SF GARAGE, 124 SF FOYER EXTENSION. FEE SUMMARY Plan Check: $405.63 Permit: $624.05 SMIP Res: $4.76 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,034.44 SETBACKS MAIN STRUCTURE Front 20- 0 ACCESSORY Front 0- 0 PARKING Existinq: 2 NOTES: Rear 0- 0 Rear 0- 0 Required: 2 PLANNING 8 ZONING Left 5- 6 Left 0- 0 Proposed: 2 Calc Valuation: Claim Valuation: Righl 0- 0 Right 0-0 sa�,sas.00 sao,000.00 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inapeetlona and final approval must be obtained. Failura [o obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKEflS' COMPENSATION DECLARATION: I,�erehy attirm under penelry oi perjury one ot the tollowing declarations: ❑ I have end will mainteln a certificate of consent to self-Insure for workers' compensation, as provitlatl for hy section 3700 of the Labor Code, for the pertormence of the work tor which ihis permit is issued. ❑ I have antl wlll maintain workers' compensation insurance, as required by section 3700 of the Labof Code, for Ihe peAormenca of tha work for which Ihis pertnit i5 issuetl. My worke�s' comp�nsatior�.lnsurance carrier and policy number are: Carrier: (This s� ❑ I cenity that in t�a peA o h � compensatlon laws of or �, a comply with ihese pr ion Applicent SignaWre: WARNING:FAILURETOS UREWORKERS'COMPEf TMOUSAND DOLLARE (5100,OW), IN ADDRION TO THE LICENSED CONTRACTORS DECLARA710N: I hereby aHirm Iha! I am torce and eflect. Lia» _ Contrectors Signature: CONSTRUCTION LENDING AGENCV"� � ❑ I hereby aHirtn that Ihere is a consiruction lending Lenders Name: Signatura: OWNER-BUILDER DECLARA710N5: Policy Number: ane hundred dollers ($700) or less.) (hich ihis pertnit is issued, I shall not employ any person in any menner so es to become subject to Ihe workers' I shoultl become subject to Ihe workers' compensation provisions of Section 3700 of t�e LaDor Code, I shall fonhwith _ oa�a: /'o o�G � S SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL NES UP TOONE HUNDRED i PFiOVIDED FOR IN SECTION 3IW OF THE IABOR CODE, INrEPEST, AND ATTORNEY'S FEES. 9(commancing with Section 7000) of Division 3 of �he Business er�Professions Coda, antl my license is in tull CI855 # `�� Date: for �he performance ot the work br which ihis permit is issuetl. (Sec. 3097, Civil Cotle). LendeYs Atltlress: Date: I hereby aNirm ihat under penelry of perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to conslrucL alter, improve, tlemolish, or repair eny structure, pnor to its issuence, also requires the applicaM for such permit to file a signed statemant thet he or she is licensed pursuani to Ihe provisions of the Contractors License Lew (Chapter 9(commencing wlth Section 7000) of Division 3 of the Business and Professions Catle) or that he ar s�e is exempt Iherelrom and t�e basis for fhe allegetl exemption. Any violation at Sactlon 7031.5 by eny epplicant for a permit subjects the epplicant to e civil penalry ot not mora Ihan live �untlretl dollars (5500).): ❑ I, as owner of Ihe property, or my employees with weges es their sole compensation, WIL� DO TME WORK, and the slructure Is not intendetl or offered lor sale (Sec. 7044, Business antl Protessions Code: The Comracmrs License Law does not appiy to an owner of propeny who builtls or improves Ihereon, end who does such work himself or herseli or ihrough his or her own employees, provitletl ihat such improvemants are not intentled or offerad for sale. II, �owever, ihe builtling or imprcvement is sold wi�hin one year of completion, ihe ownerbuilder will heve Ihe burden of proving ihai he or she did not build or improve br purpose of sale.). 0 I, as owner of the property, am E%CLUSIVELY GONTRACTING WITH LICENSED CONTRACTORS lo construct tha projeCt (Sec. 7044, Business and Professions Cotle: Tlie contractors License Ww does not apply to en owner oi pmperty who builds or improves thereon, and who crontracis for such project with a comracbr(s) license pursuant to Ihe Comracbrs License Laws.). ❑ I am eaempt under sec. Business and Professions Cotle br this reason: SignaWre: Date: Owner ID verifietl by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Venfication ot Ownership Dy (�ype of document, i.e. - pmpeny tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: ❑ I hereby certity t�a� no exwvation five (5) or more feet in tlepth inm which a person Is raquired to descend, will be meda in connection with work authorizetl by �his permit, end ihat no building structure, scalloltlinq, (alsework, or demolition or dismantling ihereoi, will he more Ihan thirry-siz (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Ttle B, California Atlministrative Code). ❑ As owner-buildar, 1 will not employ enyone to do work which would require e permit irom the Division of Intlustriel Safety, as notetl above, unless such person has a permit to tlo such work from the division. Signatura: Oete: Division of Industnal Safery Permit Number: CERTIFICATE OF COMPLJANCE AU7HORIZATION OF ENiRY: I cenify untler penalty of perjury that I have read this epplication and state tha� the information given is correct I agr mpl ith e si s and ciry ordinences relating to building constmction, and authorize representatives ol Ihe City of Costa Mesa to enter upon ihe a6ove-des ed ope�ryn e on uryoses. I agrae not m xcupy or allow ocwpancy ot any building authorized hy this permit umil final inspection. CODE �. INSPECTIONTYPE 7616 Fixetl System Finel Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2446 a6 � INiIilALS COOE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fira Prevention 220 Final Planning Appro�al 222 Final5lte 250 Final BuiltlincyOccupancy D�TE INTRIRLS To: NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 (� City of Costa Mesa ( ) City of Newport Beach ( ) Counry of Orange Applicant: ►7 Address: 2Q �0 2 1'�,ECA,E�74' DR � Ci"�CN-�- /^A ��, C_� . Telephone Number. �' �q 1 S9-C"i" �7 �ov� TracUParcel and Lot Number(s)! �.l'1� Z�n 2—� 1 Location of Project: Zq Co Z PEMR /4 l�n Number of Square Feet of: Residehtial Space Commercial and Industrial Space Commercial/Inqustrial Project is: (Check One) _ Warehouse _ R8D � Movie 7heater Mini-storage Heavy Industrial Regional Shops Light Industrial This project is exempt because SCO2 x $1.84 x $ .30 _ Motel Bank _ Neighborhood Shops _ RacqueUHeaRh _ Hotel _ MedicalOffice _ Office Park 3289 '• District Receipt No. Plan Check No. -�i�2,�1 � O$ Total � �. i�34 Total Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Appticant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The 8uilding Pemrts to� this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. By: Authorized The above representation as to square footage is true. Applicant true, then this certificate shall automatically terminate and the a� if it is lat r etefmined that such representa6ons are not ity/Co� shajF�e notified. � Date: ��"f/'l9 �/ / // Yi��'f�l �___�.�� UCT 26 199 8 NM/a1034.88 RCPTq:81-0049652 197712 �C.�'� M� 9 o. � > r " J '`a„we„m d`' {�ia)�sa-sz�a • Fa:(�ia)�sa-aess dob Address: 2962 PEMBA DR Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address CITY OF COSTA MESA BUILDING DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT GARAGE AND BEDROOM 13926231' PATRICK KENNEDY 257SANTAISABEL COSTA MESA, CA SCHUREMAN, ROBERT A TR 2962 PEMBA DR COSTA MESA, CA Phone: (714)646-7686 Zip: 92626 Phone: Zip: 92626 Contractor: KENNEDYS CONSTRUCTION Address: 257 SANTA ISABEL CA Phone: (714) 646-7686 COSTA MESA � Zip: 92626 License: 324307 PERMIT NUMBER E99-01103 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 11/22/1999 Issued: 11/22/1999 ISSUED BY: �/ / / SCOPE OF PERMIT ELECTRICAL FOR NEW GARAGE AND GARAGE TO BEDROOM CONVERSION, 25 OUTLETS, 17 LIGHTS, 10 SWITCHES AND 1 EXHAUST FAN. REF:B99-07351 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 7000a Molors to 1hp Motors to 70hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $12.10 $23.65 511.00 $0.00 $4.75 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 11 25 10 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 7 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or ride) CirwS (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 50.00 50.00 50.00 TOTAL CALCULATED FEES 575.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permi( shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for Ihe work authorized under Ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred inepections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 V WORKERS' COMPENSATION DECLARATION: I hereby aHirm untler penelty of perlury one of ihe foliowing declarations: ❑ I have an will maintain a certificate of consent m self-Insure tor workers' compensation, es provided tor by section 3700 of Ihe Labor Code, for ihe pertormance oi the wo which ihis permit is issuetl. hava ana will maintain workers' compensaGon insurence, es requirad by section 3700 of t�e Lebor Code, for ihe perfortnance oi Ne work for which UIs pertnit is issuetl. My worke3 compensation Insurance carrier end policy number are: Carrier. (This sectio e d nat be ❑ I certify ihat in the compensetion lews comply with these p Applicant Signeture: � THOUSAND OOLL4RE ($100,0p0), IN LICENSED CONTRACTORS DECLARATION: Poliry Number: e/tlg one hundred dallers (3100) o�less.) dhich this permit is issuetl, I shall not employ any person in eny manner so as to become subject to the workers' I shoultl becrome subieq to the workers' compensation provisions ot Section 3700 0l the Labor Code, I shall forthwith / Date: ��;�� 7 IS UNLAWFUL AND SHALL SUBIEGT AN EMPIOYER TO CRIMJNAL PENALilES AND CNI FINES UP TOIXJE HUNDRED iTION, DAMAGES AS PROVIDED FOH IN SECTION 37060F iHE LABOR ODDE. INiEFEST, M1D ATTORNEY'S FEES. I hareby aHirm that I am licensed und provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl�bfessions Code, antl my license is in full fOrte antl BNBCt. LiC. » Class a 0 Contradofs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is a construction lending agency tor the pedormance of ihe work for which Ihis pertnit is issuetl. (Sec. 3097, Civil Cotle). Lender s Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lenders Adtlress: Data: I hereby aNirm ihat under penalty of perjury ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit m wnstmq, elter, improve, demolish, or repair any stmcWre, prior to its issuance, also requires the applicant for such permit to fila e signed stetemen� tha� he or she Is licensetl pursuant to ihe provisions ot ihe Contractors Llcense Lew (Chapter 9(commencing with Section 7000) of Division 3 of �he Business antl Protessions Code) or ihat he or she is exempt iherefrom antl the basis tor i�e alleged exemption. Any violation of Section 7031.5 by any apPlicant tor a permit subjects the applicant to a civil penalry of not more than Ilve hundred dollars ($500).): ❑ I, as owner of Ihe property, or my employees with weges es their sole compensation, WILL DO THE WORK, end ihe structure i5 not intendetl or oNered for sale (Sec. 7044, Business entl Professions Code: The Contractors License Law tloes not apply to en owner ol property who builds or improves thareon, antl who does such work himself or herself or through his or her own employees, provided ihat such improvements ere not intended or oRered for sale. tl, however, ihe builtling or improvement is sold within one year ot completion, the owner-builder will have ihe 6urtlen of proving that he or she tlitl not builtl oi improve for purpose of seleJ. ❑ I, as owner ol ihe properry, am EICCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Pmfessions Code: The contrectors License Law does not apply to en owner of property who builtls or im0�a�es thereon, and who con�racts for such proleci with a comractor(s) license pursuant to the Contractors License Lews.). ❑ I am exempt under sec. Signature: Owner ID verified by driver5license. ❑ Ve5 ❑ No Business and Professions Cotle for ihis reason: Verification of Ownership by (type of CoamenL i.e. � property taz bill or deed): DIVISION OF INDUSTRIA� SAFE7V PERMIT CERTIPICATION: Driver's License No. Date: Expires: ❑ I here6y certity that no excavation live (5) or more faet In tlepih inro whlch a person I5 reQuired to descentl, will �e matle in connection with work aulhorizetl by this permit, antl that no building siructure, scaffolding, falsework, or demolition or dismantling iheraot, will he more ihan thirty-sia (36) leet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Celitornia Adminisirative Code). ❑ As owner�builder, I will not employ enyone to do work which would require a pertnit fmm the Division of IndusMal Sa(ety, as notetl above, unless such person has a permit to do such work from ihe tlivision. Signeture: Date: Division of Indusirial Salery Permit Number: CER7IFlCATE OF COMPLJANCE� D AUTH 710N OF ENTRY: I cenity under panalty of perjury that I hava raad this application and stale Ihat ihe information given is correG. I agrea to cycyy th zJl',€tate I and iry ortlinances relating to building construction, end euthorize representatives of the Ciry of Costa Mesa to enter upon �he ebove-tlescnbedp(opE r my�ecbo urpos I egree not to occupy or allow occupancy of any building authorized by this pertnit until linel inspection. COpE L INSPECTIONTYPE p�E NI TRIALS 1616 Fixed System Final Fira Prevention 1266 200 Pool Spa Finel Final Re-Roof 201 Final BIaWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 FinalOemolilion 26a6�8 //-��e `'7S � Date COOE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final euilding/Occupancy jIRT� INTITIALS I 31 Qo � .� DATE AP. No. LOT ]14 TRACT 35?� FIRE ZONE, DESCRIPTION OF WORK TES. INSPECTIONS /.,i,r.,;� � DATE I GROUP TR�.T TYPE V ZONE SUBCONTRACTOR OCCUPANCY Form Z10—SM-11-59 5-B P Lof 124 - Tract 3529 .. �..r`'.��s�'� COS7A MESA BUILDING-SAFEN DEPARTMENT P. O. BOX 9i7 COBTA MEBA. CALIFORNIA For Applicanf fo Fill In Compleiely TYp6 OR PRINT _ AODRE68 2962 Pemba Drive COSTA MF-SA CALIFORNIA OWNER Elken Develonment Co..Inc, � ARCHITECT �E�. MI 55.Placentia Avenue �TCTNo: 61195 ' No: MI 6-3227 SIZE c� NO, OF BILGB. OF LOT p� � Xlnn i I Now oN LOT USE OF SBTBACK LINB PpOM CENTeR OP BTHeei SO t REAR YARC SIOE YARD I LEFT S t� I R�GHT � DESCRIPiION OF WORK, rcrrw�n � - n mov�n� i n�+cmv�ian i BUILDING i8OO SF NO. OF '7 SIZE ROOMS �y�y Iy STORIES 1 EXTERIOR W�{. I ROOF ryV�V[� WOOD COVERING illGP.n GovERING SHINGlES IISE OF BUILDING AND WORK TO BE PERFORMED n��...1.. a,.«.]t. n....�A.. ..A _'_o__ —" — _'_____— __ �__ Attached Gara e P�nN 2 BR 1 HEREBY ACKNOWLEOGE THAT � VE PEAD THI APPLIGTIO�.' TH! AMOUM BXOWN UNDeq VpLUAT�ON IB FOH TH! AND BTATE THAT XE ABOYE IH RRECT EE TO GOM- pUpp08E OF EBTABLIBHING q pERMIT FEE ONLY. PLY WITH ALL ORDINANCE6 D T LAW LATN- BUILDIN6 CO ON. /� - ' � 81GNATURE F� .. /! � �' .w An.. FEE R£CElVED i3-� APPLICATI F d�lA �MESA BSit�� For Office Use Only RECEIPT NO. �PC//R�MI`T �NOy. �!/1 / / i PECE�VEO BY ATE RECEIVED �ATE IBSUE �,� �-;�-L� I �, �31 BUILDING ADDREHS COSTA MESA. CALIFORNIA FIRE ZONIPIG ZONE NO.OP n U6E OF NEW R�� I PUN9 G 9UIL�ING_/� W �ece� .� — . . (CENTfiR LIN@ 8TJ APPROVEO /� � � n k S 6 �